The latest medical research on General Practice (Family Medicine)

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about general practice (family medicine) gathered by our medical AI research bot.

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Why patients attend after-hours medical services: a cross-sectional survey of patients across the Australian Capital Territory.

Australian Journal of Primary Health

Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system.

A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs).

Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n=1149), 16% from WIC (n=317), 10% from MDS (n=193), and 17% from EDs (n=333). Most patients presented with self-rated new issues (n=987, 49.5%) and were uncertain of the urgency of their issues (n=723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care.

Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care.

Overweight and obesity management in musculo-skeletal primary care: a survey of Australian health practitioners exploring 'the elephant in the room'.

Australian Journal of Primary Health

Overweight and obesity has a bi-directional association with the growing burden of musculoskeletal (MSk) dysfunction and pain. It seems inevitable that MSk practitioners will see increasing numbers of patients who are overweight and or obese and require this to be addressed as part of their management. Little evidence exists to describe the engagement of patients and their MSk practitioner in weight management as an adjunct or direct component of their intervention or therapy.

A self-administered electronic survey was constructed with 13 items to collect self-reported data from Australian practitioners who have a focus on MSk management. The target group was from a multidisciplinary MSk network of 350 members.

A total of 204 completed surveys were analysed from respondents working in one of seven MSk- related professions. It was found that 70% of patients/clients seen by respondents were overweight or obese and that <18% of these patients had weight management included as part of their treatment.

Sixty percent of the respondents in this survey indicated that they do not include weight management as part of their practice despite 70% of their patients/clients being overweight and or obese. With the exception of Medical Practitioners and Exercise Physiologists, in this survey, the other therapists including Chiropractors, Osteopaths, Physiotherapists and Occupational Therapists, indicated that they lacked confidence, knowledge and methods to engage a systematic approach to weight management with their patients/clients.

Interaction between patient and general practitioner according to the patient body weight: a cross-sectional survey.

Family Practice

To analyse whether patient-general practitioner (GP) interaction, measured by their disagreement, varies among overweight or obese patients compared with normal-weight patients.

Twenty-seven GPs and 585 patients participated in the quantitative phase of the multidisciplinary INTERMEDE project and answered "mirrored" questionnaires collecting both GPs and patients' perceptions on information and advice given at the end of the consultation. Multilevel logistic regressions were performed to explore associations between patient body mass index (BMI) and patient-GP disagreement on information and advice given during the consultation.

Disagreement increased with the patients' excess weight, and it was particularly pronounced for advice given by GPs on weight and lifestyle issues. Compared with patients with a "normal" BMI, overweight patients were more likely to disagree with their GP regarding advice given on weight loss (odds ratio [OR] = 10.7, 95% confidence interval [CI] = 4.1-27.3), advice given on doing more physical activity (OR = 1.9, 95% CI = 1.1-3.4), and nutritional advice (OR = 2.9, 95% CI = 1.5-5.6).

These disagreements could degrade the quality of patient-physician relationship. Our study provides an opportunity for GPs to reflect on how they communicate with overweight and obese patients, particularly with regard to lifestyle and weight-related advice and interventions taking into account the patient's representations.

Assessing the Efficacy of a Tobacco Prevention and Control Intervention in a Rural Area of India: A Quasi-Experimental Study.

Indian J Community Medicine

Tobacco use, disproportionately higher in rural areas, is a major cause of morbidity and mortality in India. Interventions to reduce tobacco use in rural areas are scarce.

The objective of this study was to assess the efficacy of a community-directed tobacco prevention intervention in reducing tobacco use in rural areas.

A single-group pre-/postquasi-experimental study was conducted in Lakhmapur village, Maharashtra. Data were collected from one adult each in 296 and 307 randomly selected village households before and at the end of intervention, respectively.

Between pretest and posttest, reported tobacco use reduced from 56.4% to 23.5%; average daily expenditure on tobacco from INR 16.07 to INR 9.47, respectively. A logistic model, controlling for sociodemographic variables, showed that the postintervention group had a significantly lower likelihood of using tobacco; however, males and lower education subgroups were more likely to use.

Multipronged community-based interventions involving schools, students, teachers, frontline workers, elected leaders, and community influencers hold promise in reducing tobacco use in rural India.

Capacity Building of "Accredited Social Health Activist" under Rural Health Training Center Regarding Mental Health: An Interventional Study.

Indian J Community Medicine

Mental health is one of the critical health requirements that society needs to address in the present century. Accredited Social Health Activist (ASHA) can play an important role in identifying mental health problems at the earliest and help in improving community health status.

The objective of this study was to evaluate the effectiveness of a mental health education program on knowledge, attitude, and practices (KAP) of ASHAs.

An intervention study was conducted to empower ASHAs for providing mental health services at a district located in Western India during 2016 and 2017. A semi-structured questionnaire was administered to assess KAP regarding mental health in intervention and control groups before and post intervention. An educational program was imparted in two batches. Hybrid methods for imparting teaching/training were utilized. "Paired t-test" was applied to compare pre- and post-results in intervention group and "unpaired t-test" for baseline comparison.

There was a statistically significant improvement in KAP of ASHAs after intervention. Majority of ASHAs referred cases of mental health problems to government tertiary care hospitals.

The study indicates that it is possible to empower ASHAs with a short course related to mental health to achieve effective outcomes in terms of improved knowledge, attitudes, and practices.

A Study on Epidemiology of Unintentional Childhood Injury at One of the Districts of Gujarat State: An Indian Council of Medical Research Task Force Study.

Indian J Community Medicine

Childhood injuries are a less explored area of public health. In the presence of public health problems such as communicable and noncommunicable diseases, childhood injury has gained less attention from the health system.

The aim of the study was to assess the prevalence of various types of unintentional injuries (UI) amongst children and to assess the factors associated with same.

The study was conducted at Ahmedabad District of Gujarat State, and this is a cross-sectional sStudy.

The current study was a part of a multicentric national level research supported by Indian Council of Medical Research. Total 11 sites were selected across India, which all followed a uniform methodology. One of the selected sites was Dholka taluka of Ahmedabad district, Gujarat. This cross-sectional study was conducted in 2341 households. The study participants were children aged from 6 months up to 18 years. A total of 3018 children and their caretakers were interviewed using software-based questionnaire.

Statistical analysis was performed by frequencies and Percentage, Chi-square Test, Z-Test.

The overall prevalence of injuries was 7.62%. Gender and area of residence were significantly associated with UI. Fall-related injuries had the highest prevalence (3.38%), followed by road traffic injuries (RTI) (1.62%). The prevalence of burn-related injuries and poisoning was higher among females compared to males. No mortality was observed due to UI.

Majority of the injuries were of minor or trivial type. Fall-related injury and RTI were the most common types of UIs among children.

Body Image and Its Association with Depression, Anxiety, and Self-esteem among College going Students: A Study from Northeast India.

Indian J Community Medicine

Body image is conceptualized as a subjective perception of an individual one's own body and on how he/she is seen by others, and its distortion can lead to poor self-esteem and affect psychological adjustment among the youth. The objectives of the study were to assess body image and to see the association with depression, anxiety, and self-esteem among students.

A cross-sectional correlational study was conducted among undergraduate students in Shillong, Meghalaya. The researcher used random sampling as for the selection of college. The Krejcie and Morgan (1970) sampling method was used to determine the sample size by a table using the sample size formula for the finite population. A total of 384 respondents were selected for the study, out of which 358 were included for the final analysis. Sociodemographic datasheet, Multidimensional Body-Self Relations Questionnaire-Appearance Scales, Rosenberg Self-Esteem Scale, Beck Depression Inventory-II, and Hamilton Anxiety Rating Scale were administered.

Regression analysis showed self-esteem and anxiety contribute significantly to the prediction of body image satisfaction among students (F[4353] = 3.816, P = 0.001), accounting for a 15.1% variance.

Significant proportion of students were dissatisfied with their body image. Furthermore, a study reported that body image influences psychological well-being. There is a need for preventive measures and making these young people aware of the importance of both physical and mental health.

Quality of Referral, Admission Status, and Outcome of Neonates Referred to Pediatric Emergency of a Tertiary Care Institution in North India.

Indian J Community Medicine

This study was planned to study the existing status of neonatal transport in North India after the introduction of National Ambulance Service (NAS). We evaluated the quality of referral, admission status, and outcome of referred neonates.

We enrolled neonates admitted between March 2016 and October 2016, excluding neonates referred from the outpatient department. Information was collected from referral slips, interviewing accompanying persons and observation.

Sixty-one percent were referred from government hospitals with "sick newborn care units" contributing to maximum. The main mode of transport was ambulance in 80% and referral notes were available in the majority but incomplete in majority. Sepsis (39%), jaundice (16%), and birth asphyxia (13%) were the most common diagnoses. Half of the neonates were hemodynamically unstable. Twenty-seven percent had poor circulation, 15% were hypoxic, 9% hypoglycemic, and 8% hypothermic. Twenty-two percent either died or "left against medical advice" with a high probability of death.

NAS is utilized for transporting neonates. However, there are quality gaps which need attention to develop it into efficient referral system.

Autopsy versus Clinical Decisions Regarding Causes of Maternal Death in Iraq.

Indian J Community Medicine

Complications during pregnancy and childbirth are a leading cause of death and disability among women in developing countries. The target for mortality reduction is important, yet accurate data of maternal mortality remains challenging as reporting errors including misclassification of cause of death continue to pose a major challenge.

This study aimed to identify if there is any discrepancy between clinical and autopsy causes of maternal death.

A review of all maternal deaths records that had two sources for registered cause of death; one made by the obstetrician depending on clinical setting and the other by forensic medicine after autopsy and search for any discrepancies between the two sources.

A total of 468 maternal death reports were reviewed; the discrepancies were more with the second commonest cause of maternal death in Iraq which is pulmonary embolism. The review revealed that 10.1% of those clinically died because of pulmonary embolism turned to be dead from other causes; 8.7% of them from postpartum hemorrhage, and the rest from sepsis and other indirect causes.

There is a substantial discrepancy between clinical and autopsy causes of maternal death which necessitates asking for autopsy in cases of maternal mortality of uncertain cause. The use of maternal death review within 3-6 weeks of death as a tool to identify causes of maternal deaths is recommended.

Prevalence of Oral Lesions and Its Associated Risk Factors Among PLHIV Availing Anti-Retroviral Therapy from a Selected Tertiary Care Hospital, Puducherry - A Cross Sectional Analytical Study.

Indian J Community Medicine

Oral lesions are among the earliest and most important indicators of infection with human immunodeficiency virus (HIV). The presence of oral lesions has a significant impact on the physical and mental health of the PLHIV. Hence, a novel attempt is made to assess the prevalence of various types of oral lesions among the adult people living with human immunodeficiency virus (PLHIV) undergoing antiretroviral therapy.

In this facility-based cross-sectional study, a total of 239 out of 300 eligible PLHIV were assessed between September and October 2018. All consecutive eligible patients encountered during the data collection period were included. Oral examination was carried out using disposable mouth mirrors, sterile piece of cotton, and bright illuminated torch.

The prevalence of oral mucosal abnormalities was found to be 25% (95% confidence interval: 20.03-30.97). The most prevalent oral lesions were acute necrotizing ulcerative gingivitis, acute necrotizing ulcerative periodontitis, and candidiasis. CD4 count <200 cells/mm3, current tobacco use, and alcohol usage were significantly associated with the prevalence of oral lesions.

The study revealed that one-fourth of the study participants had oral lesions. Strategies for early detection and prompt treatment of oral lesions need to be planned and incorporated in the program to reduce the morbidity due to oral lesions.

What Explains the Rural-Urban Gap in the Use of Hygienic Methods of Menstrual Protection among Youth in the East Indian State of Bihar?

Indian J Community Medicine

Menstrual hygiene management has become a globally recognized public health issue. As evidenced by the National Family Health Survey-4 (NFHS-4), among the states in India, Bihar accounts for the lowest use of hygienic methods of menstrual protection among youth. Further, the use in rural areas of Bihar is substantially lower than in urban areas.

Therefore, using NFHS-4 data, this study endeavors to explore the socioeconomic and demographic factors in explaining the rural-urban gap in the use of hygienic methods of menstrual protection among youth in Bihar.

A logistic regression model is used to identify the socioeconomic and demographic determinants of the use of hygienic methods, and Fairlie's decomposition technique is employed to compute the rural-urban difference in the use, and then to decompose these differentials into their separate underlying factors.

Findings from logistic regression analysis reveal that women's education, household wealth, media exposure, use of toilet facility, and awareness of sexually transmitted infections (STIs) are the significant determinants influencing the use of hygienic methods of menstrual protection. Results from decomposition analysis indicate that while use of improved toilet facility and mass media exposure among youth reduce the rural-urban gap, the unequal distribution of women's educational qualification, wealth index, marital status, and awareness of STIs has tended to widen the gap.

The findings suggest promotion of menstrual hygiene practices, enhancement of menstrual hygiene knowledge, opportunities for women's education, better sanitation practices, exposure of mass media, and economic incentives among youth in rural Bihar.

Impact of Self-Help Groups among Persons With Disabilities in Rural Karnataka - A Comparative, Cross-Sectional Study.

Indian J Community Medicine

The prime concern for an individual with disability is independence. Self-help groups (SHGs) provide opportunities for those with such needs.

The objectives of the study were (i) to assess the impact of SHGs on the livelihood, social inclusion, and community participation of those with disability and (ii) to evaluate the self-esteem and assess the role of such SHGs among those with disability.

This was a community-based, cross-sectional study. An interview schedule captured responses to standardized questionnaires (community-based rehabilitation assessment tool, Rosenberg's self-esteem score, and Social Inclusion Scale). Responses were scored and compared among the two groups of those with disability (member or nonmember of SHGs).

The median scores for all our outcome variables were found to be more among those with disabilities enrolled in SHGs than those who were not with a significant association in the component of empowerment, sociocommunity participation, social inclusion, and self-esteem.

SHGs improve social and community participation of individuals with disability. It empowers them to lead independent lives and also contributes to social inclusion.